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PubMed1998

Expert systems in anesthesiology.

There are only a limited number of computer-based systems designed to support anesthesiologists in the operating room. This is evident from the very small number of publications on this topic. These systems may be classified by the functions they perform and include: intelligent anesthesia workstations (with current data acquisition, conditioning and analysis subsystems), systems to detect critical conditions in patients (including expert systems in smart alarm capacity), anesthesia management systems (for planning and management) and drug administration systems. Drug administration systems may be subdivided into open-loop and closed-loop systems. The techniques applied for design of such systems vary extensively. There are traditional rule-based expert systems and probability-based systems, and more recently developed artificial intelligence methods, such as neural networks and fuzzy logic. Computers are valuable tools that have the potential to assist anesthesiologists in carrying out cumbersome and monotonous processes. Future efforts may result in the development of sophisticated systems capable of assuming more responsibilities and of reducing human workload and stress.

Journal Article↗

PubMed1990

Expert systems as a diagnostic aid in otoneurology.

Expert systems (ES) are a new tool for information processing developed by the branch of computer science known as artificial intelligence. ES are capable of solving problems in a given domain by using the knowledge and emulating the behaviour of specialists in that field. ES can be used as powerful tools for education since they are able to justify their own conclusions and to make the underlying reasoning explicit. This paper presents 'Vertigo', an ES aimed at the classification and diagnosis of different forms of dizziness. It has been conceived mainly as a teaching tool in otoneurological departments. The rationale of this project, its development, the structure and the use of the system are described. So far, 'Vertigo' has been tested on more than 200 cases of dizziness and is presently being used by ENT residents during their otoneurology stage.

Diagnosis, Computer-Assisted↗

PubMed1989

Expert systems in medicine.

The emergence of the artificial intelligence (AI) in computer technology and its application in the medical field enables the researchers to carry out such intelligent activities like image processing, medical reasoning systems, clinical decision supporting and natural language understanding, etc. A gastroenterological expert system application is briefly demonstrated in this paper. Similar expert systems can be seen to be useful in the research of gastrointestinal cytoprotection, including the plan of different compounds with cytoprotective effect, experimental and clinical medical research.

Decision Making, Computer-Assisted↗

PubMed1996

Evaluation of an expert system linked to a rapid antibiotic susceptibility testing system for the detection of beta-lactam resistance phenotypes.

Interpretive reading of antibiotic disc agar diffusion tests indicates the resistance mechanisms, if any, expressed by a bacterium. An expert system for determining resistance mechanisms using rapid automated antibiotic susceptibility tests has been developed. The beta-lactam susceptibility of each of 300 strains of clinically significant species of enterobacteria, displaying natural and acquired resistance mechanisms, was determined by disc agar diffusion and by a rapid automated method of susceptibility testing associated with an expert system. For every strain, the conclusion of the expert analysis of the automated test was compared with the commonly accepted interpretation of disc agar diffusion tests. Of the 300 strains studied, 275 were similarly interpreted (91.7% agreement). The susceptible and naturally beta-lactam-resistant phenotypes (wild phenotypes) were equally recognized by both methods. Similarly, the results of the two methods concurred for most of the acquired resistance phenotypes. However, for 25 strains (8.3%) the results diverged. The expert system proposed an erroneous phenotype (5 strains), several phenotypes including the correct one (17 strains), or no phenotype (1 strain). For 2 strains the natural resistance mechanism was not detected at first by the automated method but was subsequently deduced by the expert analysis according to bacterial identification. These results demonstrate that satisfactory interpretive reading of automated antibiotic susceptibility tests is possible in 4 to 5 hours but requires careful selection of the antibiotics tested as phenotypic markers.

Anti-Bacterial Agents↗

PubMed1993

PEIRS: a pathologist-maintained expert system for the interpretation of chemical pathology reports.

Provision of a comprehensive interpretative service is an important challenge facing chemical pathologists. Attempts to automate report interpretation using expert systems have been limited in the past by the difficulties of rule base maintenance. We have applied a novel knowledge acquisition technique, ripple down rules, in the development of PEIRS (Pathology Expert Interpretative Reporting System), a user-maintained expert system for automating chemical pathology report interpretation. We created over 950 rules for thyroid function tests, arterial blood gases and other test sub-groups in 9 mths of operation. A staff pathologist performed all maintenance tasks as part of his routine duties without any need for computer programming skills. No clerical staff involvement was required. Duplication of rule addition for reports requiring multiple comments was the only limitation to coverage of other high volume test groups. PEIRS is the first expert system for the automated interpretation of a range of chemical pathology reports which operates in routine use without extra staffing requirements. PEIRS does not require "knowledge engineering" expertise. Thus, the knowledge base is flexible and can be easily maintained and updated by the pathologist. Expert systems based on ripple down rules should enable pathologists to provide a comprehensive automated interpretative service within the context of the total testing process.

Chemistry, Clinical↗

PubMedDate not supplied

HyperShell: an expert system shell in a hypermedia environment--application in medical audiology.

HyperShell is an expert system shell developed in a hypermedia environment. Several artificial intelligence techniques such as frames and semantic networks are used in an original interpretation to enhance the interaction between the user and the program. The typical navigation tools of hypermedia such as clickable buttons and text search are extended to the semantic structure of HyperShell, creating a set of new tools. Examples from a medical expert system (Audex HM) developed in HyperShell are described.

Audiology↗

PubMed1997

Evaluation of the expert system for respiratory therapy of newborns on archival data.

The aim of this study was to evaluate the artificial ventilation expert system for neonates (AVES-N) using archival data. The recommendations of the system were compared to the decisions made by the expert-physician in the same clinical situation (patient condition, respirator settings). In our retrospective study we used data of 320 newborns which were ventilated in the Neonatal Intensive Care Unit of the Vanderbilt University Hospital in Nashville (USA). Best agreement between the recommendations of the system and the decisions of the experts was found for positive end expiratory pressure (PEEP), inspired oxygen fraction (FiO2) and peak inspiratory pressure (PIP)--about 70%. Worse agreement was found for time related parameters: respiratory frequency (f) - 54%, time of inspiration (ti) - 46%, time of next blood gas analysis - 15%. The expert system advised lower FiO2 PEEP and f. The differences were smaller in a group of patients who survived than in a group of patients who died. The overall agreement of the AVES-N advice and real therapeutic actions leads to the clinical evaluation of the expert system. The differences can be attributed to a) different therapeutic strategies at 2 NICU's, b) missing data regarding complications in the data base which were not taken into account by the expert system.

Archives↗

PubMed1989

Arrhythmia analysis with an expert system.

We have developed a rule based expert system which was designed to diagnose electrocardiographic arrhythmias in several species. The program, called ECG-X, is written in OPS5 and runs under MS-DOS 2.1 and higher on an IBM-PC or AT type machine. The program uses the paper speed, the species, the temporal relationships between the P waves and the QRS complexes as well as basic information about the P and QRS morphology, and provides the user with a rhythm diagnosis consistent with rules provided by contemporary cardiac electrophysiologic knowledge.

Animals↗

PubMedDate not supplied

Prototype expert system for infusion pump maintenance.

With today's object-oriented software, knowledge-base building becomes simple. Using ServiceSoft's Service Power tools, an IMED PC-1 infusion pump prototype expert system was built. Approximately three man-weeks of work was expended to build the prototype expert system providing advice on repair to the board level. The prototype was demonstrated to the Department of Defense, and they are considering the inclusion of expert systems technology in medical equipment maintenance as one facet of their consolidation of logistic and administrative functions of the four military services' health care delivery.

Algorithms↗

PubMed2001

Analysis of the imputed female urinary incontinence data for the evaluation of expert system parameters.

We evaluated parameters for an expert system which will be designed to aid the differential diagnosis of female urinary incontinence by using knowledge discovered from data. To allow the statistical analysis, we applied means, regression and Expectation-Maximization (EM) imputation methods to fill in missing values. In addition, complete-case analysis was performed. Logistic regression results from the imputed data were reasonable. The significant parameters were mostly those that are important in the diagnostic work-up. Moreover, directions of relations between the parameters and the stress, mixed and sensory urge diagnoses were as expected. Analysis with the complete reduced data set gave clearly insufficient results. Imputed values had a moderate agreement, but odds ratios and classification accuracies of logistic regression equations were similar. Results suggest that with these data, simpler methods may be used to allow multivariate analysis and knowledge discovery, when better methods, such as EM imputation, are unavailable. Cluster analysis detected clusters corresponding to the small normal class, but was unable to clearly separate the larger incontinence classes.

Adult↗

PubMed1996

An expert system to diagnose anemia and report results directly on hematology forms.

An attempt was made to create an expert system with sufficient accuracy to diagnose classes of anemia and report presumptive diagnoses directly on the hematology form. The system should simulate the processes of human experts who can reliably achieve diagnostic separability by pattern analysis. A hybrid expert system combining rule-based and artificial neural network (ANN) models was constructed to evaluate microcytic anemia in a 3-layered program using hematocrit (HCT), mean corpuscular volume (MCV), and coefficient of variation of cell distribution width (RDWcv) as inputs. These measurements are available as standard output on most hematology analyzers. Three categories of microcytic anemia were considered, iron deficiency (IDA), hemoglobinopathy (HEM), and anemia of chronic disease (ACD). A novel feature of the model is its construction and training using human expert input alone. Model construction is described in detail. The model's performance was evaluated with actual case data. It was successful in correctly classifying 96.5% of 473 documented cases of microcytic anemia and anemia of chronic disease. It thus exhibits sufficient accuracy for it to be considered for use in reporting microcytic anemia diagnoses on hematology forms.

Anemia↗

PubMedDate not supplied

Evaluating the appropriateness of a nurse expert system's patient assessment.

The Urological Nursing Information System (UNIS) is an expert-system prototype designed to help nurses perform patient assessments on elderly nursing home residents known to be incontinent of urine. A study was conducted to evaluate the appropriateness of the patient-assessment parameters stored in the knowledge base of UNIS. These parameters were stored as objects--a kind of template for holding related clusters of data, facts, rules, hypotheses, or any knowledge in a single conceptual unit. Each object was rated for its appropriateness by 14 nurse experts. Resulting scores ranged from +14 to -14. The effect of the nurse experts' educational backgrounds and work settings on their ratings were also analyzed. The results indicated that 95.6% of the objects received favorable ratings from the nurse experts. Educational background was not a significant factor chi 2 = 5.2, but work settings did have a significant affect chi 2 = 21.07, p = 0.01.

Aged↗

PubMed1989

Expert systems: fact or fantasy?

Within the last decade, much ado has been made about expert systems, a revolutionary technology that may strongly impact the delivery of healthcare. In the midst of endless discussions of the potential of expert systems, confusion nevertheless reigns supreme when it comes to understanding just exactly what this technology does and its function within the healthcare environment.

Expert Systems↗

PubMed2004

Fuzzy expert system in the prediction of neonatal resuscitation.

In view of the importance of anticipating the occurrence of critical situations in medicine, we propose the use of a fuzzy expert system to predict the need for advanced neonatal resuscitation efforts in the delivery room. This system relates the maternal medical, obstetric and neonatal characteristics to the clinical conditions of the newborn, providing a risk measurement of need of advanced neonatal resuscitation measures. It is structured as a fuzzy composition developed on the basis of the subjective perception of danger of nine neonatologists facing 61 antenatal and intrapartum clinical situations which provide a degree of association with the risk of occurrence of perinatal asphyxia. The resulting relational matrix describes the association between clinical factors and risk of perinatal asphyxia. Analyzing the inputs of the presence or absence of all 61 clinical factors, the system returns the rate of risk of perinatal asphyxia as output. A prospectively collected series of 304 cases of perinatal care was analyzed to ascertain system performance. The fuzzy expert system presented a sensitivity of 76.5% and specificity of 94.8% in the identification of the need for advanced neonatal resuscitation measures, considering a cut-off value of 5 on a scale ranging from 0 to 10. The area under the receiver operating characteristic curve was 0.93. The identification of risk situations plays an important role in the planning of health care. These preliminary results encourage us to develop further studies and to refine this model, which is intended to implement an auxiliary system able to help health care staff to make decisions in perinatal care.

Adolescent↗

PubMed2002

Pragmatic validity of the combined model of expert system for assessment and analysis of the actual quality overall structure of basketball players.

The authors presumed that it was possible to replace certain criteria of the expert system aimed at evaluating actual quality of basketball players, proposed by Trninić et al., with the corresponding indicators of situation-related efficiency (official statistics of the game). Hence, the aim of this study is to verify the potential of establishing such a combined model of expert system that would consist of both the evaluation criteria and certain number of objectively measurable aspects of actual quality (player's partial performance or playing efficiency) and to determine its pragmatic validity. To achieve the aim the sample comprised of 60 basketball players that were competing in the Croatian First Division League in the 1998/99 season was tested. The sample and their quality of play was described by the two different types of data: 1) the 13 situation-related efficiency data (FIBA statistics of the game) utilized to objectively assess performance or playing effectiveness of players, collected at 132 games played by 12 teams, and 2) the evaluation data, subjectively assessing actual quality of players, i.e. their perceived overall performance, collected at the end of the season from the 10 basketball trainers. On the basis of relatively high correlations within the 7 pairs of mutually equivalent variables (from 0.63 to 0.84) and the extremely high correlation (0.97) obtained between the perceived overall performance (actual quality), subjectively assessed with respect to the 19 criteria of the original expert evaluation system, and the overall performance (actual quality) assessed by the combined model (where the 8 evaluation criteria had been replaced by the 7 corresponding indicators ofplaying efficiency), it is feasible to consider the combined model of expert system as an acceptable tool for more objective and economical assessment of actual quality of basketball players.

Basketball↗

PubMed2004

Support vector machine-based expert system for reliable heartbeat recognition.

This paper presents a new solution to the expert system for reliable heartbeat recognition. The recognition system uses the support vector machine (SVM) working in the classification mode. Two different preprocessing methods for generation of features are applied. One method involves the higher order statistics (HOS) while the second the Hermite characterization of QRS complex of the registered electrocardiogram (ECG) waveform. Combining the SVM network with these preprocessing methods yields two neural classifiers, which have been combined into one final expert system. The combination of classifiers utilizes the least mean square method to optimize the weights of the weighted voting integrating scheme. The results of the performed numerical experiments for the recognition of 13 heart rhythm types on the basis of ECG waveforms confirmed the reliability and advantage of the proposed approach.

Algorithms↗

PubMedDate not supplied

An expert system for the computer-aided diagnosis of dizziness and vertigo.

We have developed an expert system to assist in the diagnostic work-up of otoneurological cases. Our otoneurological expert system ONE takes advantage of both patient history and clinical measurement data in order to supply all possible information about the patient's symptoms and other findings. This paper presents ONE after its initial stage of development, which included tests with numerous patients.

Adult↗

PubMed1989

An expert system applied to the diagnosis of anemia with special reference to myelodysplastic syndromes.

An expert system is described that includes interpretation of the results from a complete blood count as well as data from bone marrow aspiration. The system utilizes Bayes' rule. It has previously been tested on 180 cases of anemia including 20 benign and malignant hematologic disorders. On the data set, the system achieved 84% satisfactory diagnoses. In the present study, patients with myelodysplastic syndromes and with disorders of heme synthesis have been added to the test cases. For support, the expert system requires an IBM Personal Computer or equivalent. The program is available commercially (Coulter Electronics, Hialeah, FL).

Anemia↗